A change of [birth] plan…

As we say in the UK, there’s been a slight technical hitch…

No sooner had I gotten my head to that zenlike state of pre-birth blissful ignorance calm excitement (based on doing it all naturally, or as far as possible, pending any surprises) but I had a hard knock back down to earth.

Long story short: Turns out I’m not going to get to give birth in the lovely Birth Centre, which just about broke my heart (if it wasn’t a stone cold British heart).

Damn you, gestational diabetes!

The way I found out was particularly shocking. By which I mean, it wasn’t really that shocking but now I’m on wind down from the professional world of work, I’m sort of in a state of blissful relaxation and it was a bit of a shock to discover that everything I’d been visualising in my head wasn’t actually going to happen.

The basic problem is that if you have diabetes (including gestational, including diet-controlled and not insulin-dependent or medicated in any way), you have to be treated by a consultant. And if you’re under consultant care, you have to give birth on the delivery ward. The reason is, if you have diabetes then the protocol during birth is to be monitored continuously. They can’t monitor continuously in the Birth Centre as it’s a midwife led unit.

So instead of giving birth in the place I’d envisaged (huge, softly lit, nicely paint-jobbed pseudo hotel room), I have to give birth in a standard hospital room – with a bed with bars on, and medical equipment beeping and nasty bright light white roomed paper curtained yuckiness.

Now, someone could have told me this weeks ago when I was diagnosed with gestational diabetes but they didn’t. Mainly because the diabetes people are a bit sh*t and don’t operate in a joined up way at all. (I really do not see eye to eye with the diabetes people and now I especially don’t.) So the way I found out was from my midwife (the lovely, lifesaving L) when I asked if I could take a picture of the birth suite for T, as he hasn’t seen it (he figures he’ll see enough of it by the time I’ve given birth and I’m inclined to agree) and instead of being led to the lovely hotel-room-like birth centre room, she led me down the horrible hospital corridor to a yucky hospital room with wires and stuff hanging all over the place.

Naturally, I didn’t look happy at this – L realised there’d been a massive misunderstanding and told me I should have been told there was no frickin’ way I could use the Birth Centre if I was “diabetic”, and clearly I was beginning to change my mind about the whole thing and considering how I could do a home birth! And swiftly took me to the hospital cafe to talk it all out…

The thing is, it’s taken a vast amount of psychic energy and general emotional thought to get myself to a space where I felt okay with the idea of childbirth and was largely managing my emotions and anxieties concerning pregnancy loss fears and fear of pain etc. I was actually completely fine about the whole thing, and now I feel like I have to unravel all of my mental preparations and change my idea of what the birth is actually going to be like. And this is all for something that could happen any time.

It’s frustrating, for sure. And thing is, I realise that everything could change on the day and I was prepared for that (eg If I have to have a caesarian rather than vaginal birth) but this is changing the entire birth plan I’d envisaged before my waters have even broken.

I asked if there was anything I could do, but L said that the protocol at our hospital for those who’ve been diagnosed as diabetic (using the goddamn Glucose Tolerance Test) even if well controlled by diet mean that patients have to have continuous monitoring during birth. This is because of the NICE guidelines which say that for controlled diabetics, they should be allowed only to get to 40+6 (ie 41 weeks gestation, one week overdue) before being induced, and they should also be subject to continuous monitoring during birth because apparently they’re more at risk of the baby being in distress.

Now, the NICE guidelines apply to insulin controlled diabetics. I am not on insulin or metformin. Quite frankly I am not inclined to believe I am diabetic but allegedly because I “failed” the glucose tolerance test, I am now classed as diabetic. (Based on my body’s ability to metabolise a syrupy glucose drink over two hours of inactivity. Which is something I do every day… NOT.) By all accounts it’s likely it’ll go away after the baby’s born, and anyway, my private doctor said these tests do not account for racial differences (I am not white) and in his opinion, the normal glucose levels for different races are different and it should be expected that my race has a higher baseline level of blood sugar and can still be healthy / non-diabetic. Which just makes my blood boil. (I’m already mad that the diabetic dietician tried to make me eat more carbs that I don’t even usually eat – such as diet fizzy drinks, more bread – so they could then put me on metformin. WTF?)

The frustrating thing is, it is not a decision for me or for L and I don’t have much choice. Basically that’s my hospital’s protocol so unless I start looking for someone else to give birth (bearing in mind this could happen any day now – I’m now at 38 weeks) I have to accept that. L said this was just how it worked in this hospital and whilst she sympathised with me, she would not feel comfortable looking after me (as my dedicated midwife) against the consultant advice / hospital protocol (for continuous monitoring). Which I can completely understand from her point of view.

My only option really is to appeal to the diabetic obstetrician (who is very nice and an advocate of natural childbirth and minimal intervention) to see if she thinks I need continuous monitoring. But… I also feel like things like this make us doubt our own opinions. I mean, if doctors tell me my baby needs continuous monitoring and this is my first baby to make it to childbirth then I don’t feel in a confident position to tell them I don’t want that. (In a midwife led unit, the most monitoring they can do is doppler in between contractions, which doesn’t tell you if the baby’s in distress during the contraction, during which the oxygen is cut off and he’s relying on oxygenated blood reserves in the placenta, from what L explained to me. Which are apparently considered lower in certain groups of people including diabetics.)

In short, I’m not in a position of confidence to say, “I don’t want continuous monitoring” because we are made to feel we are basically endangering our baby if we don’t have it. And I don’t want to endanger my baby. Of course. I can have a feeling that it’s not necessary but then a voice in the back of my mind says, what if it is necessary? What if you refuse it and he dies? So of course I’m not going to go against what they say.

L thinks it’s just about me wanting “the nice paint job” (her words) and it’s true, the Birth Centre room is like a hundred times nicer than the delivery suite room. But it’s not just some stupid vanity or whatever or wanting to be in a hotel room. It’s the difference between wanting a relaxed home-type birth versus a medicalised, all white bright-light smelling-of-hospital whilst other women scream in the background birth. I mean I really don’t like hospitals and the only reason I was so chilled out about the birth was specifically because I’d seen the Birth Centre, which is totally un-hospital-like.

Argh. So L tried to make me feel better. She said she would “de-medicalise” the room. We could turn the lights off and have fairy lights / tea lights (all battery operated of course) and I could use the birth pool and also use the continuous monitoring that is wireless so I could move around and get in and out of the pool. So I wouldn’t be tethered to the bed, which is completely what I don’t want. (I know this sounds odd when I had initially wanted an elective caesarian but it’s precisely because of my fears about lack of control which are now coming true!) I am also absolutely averse to going on the ward after birth. It’s like my worst nightmare. I don’t want to be around other people. I want it to be just us.

L also said that she would make a concession and other than trying to de-medicalise the delivery room – and also that she would be the gatekeeper and not let anyone in without agreeing it with me (and I refused the consent for the medical student to be there as well) – that if I have a “normal” vaginal delivery without intervention or complication, that I can go recover in the Birth Centre. So if I don’t lose loads of blood and need further treatment or whatever, or have a caesarian, I can go to the original place I wanted to be rather than on the ward.

I’m getting my head around it, and T thought I was doing well as he said they should have told me ages ago so I’d have had time to get accustomed to the idea. I feel like I don’t have much choice in the matter. I mean, realistically I can’t have a home birth (and I don’t feel up to that, quite aside from our flat is tiny) and if I want to be looked after in hospital, I have to go along with what they say. I appreciate L trying to make it better for me, but it’s quite a big shift in what I’ve been gearing up to. So I’m just going to have to work on being all zen and accepting and stuff.

I think one of the big things is that I’ve done a lot of work on myself to get to this calm state, so when there are things that are knocking me out of it, they make it difficult for me to stay so relaxed. Actually one of the things completely doing my head in is one girl in my NCT group. We have a Whatsapp group and she always posts about how anxious she is and how much pain she’s in yadda yadda and I just want to tell her to shut up. She’s like super insipid and whines about everything and keeps talking about how she wants it to be over. I actually said to her today that she should try and enjoy it because some people (like me) are grateful for being pregnant as we never thought we would be.

Also, she’s a bit creepy towards me… We are the same race and I kind of feel a bit like she is a potential stalker. She has no family in this country, which I’m sympathetic about, but she really annoys me so out of everyone in the group she’s the one I least want to be friends with. (I did on first meeting until I realised how whiney she is. As an example she’s usually the last person to post on Whatsapp chats because she’ll write a load of stuff and nobody will respond.)

For example re the creepiness: she lives the closest to me out of the others in the group, but not on my estate, but pretends to everyone she lives on the estate (which is more upmarket than where she lives – outside – just to sound snobby!). She’s already told me she walks past our block of flats every day and “wonders which one yours is?” (Ummmm creepy. Glad there’s a big gate around it and she can’t get in.) She is always hanging around our estate and making out she lives there and posting on the Facebook group, like she doesn’t get that she doesn’t actually live here.

Other creepiness is she literally keeps on buying the same stuff as I have bought for our baby. Like we discuss stuff on the group and people ask what others have got and then she just buys the exact same thing I’ve already bought. It’s like she wants us to be the same race and have the exact same stuff for our babies?! I am just not comfortable with her ways. I think she wants to keep emphasising similarities or something and we are not similar!

And also doesn’t seem to take the hint that I am never inviting her round, and keeps angling for an invitation. The other day she even posted to the group, addressing me: “I think I want to get a sling like yours – do you know where I could try it out?” Clearly asking if she could come round and try mine out. Umm no. I am one of those people (British!) who don’t invite people round unless we are friends friends. And why would she think I’m going to open my brand new sling and let her try it on? Just nope. Why can’t she go to a shop and make up her own mind? She even said it again in person when we met up as a group (I tried to sit far away from her and not talk with her) and I was just like, that’s nice. I mean, if you want to buy it, buy it. Don’t expect me to use my new stuff for you!

Hmm maybe I’m just getting to grouchy pregnant state? Weird thing is, apart from this annoying girl and the whole “You have to give birth in a nasty hospital environment” thing I’m super chilled out. The others in our group were saying how I seem to be the most okay with everything and calm and stuff. I honestly think it’s because I never thought I’d get to this stage and I am grateful. I can remember this time last year feeling hopeless and depressed and thinking I’ll never get to have a child, so I’m not going to feel bad about this, or whine about the pregnancy aches and pains (okay, not that much!) and so on. I’m feeling much better now I don’t have to go into work again until after maternity leave. I’m working from home and lying around with Dog and nesting with T and I am just not going to feel bad about that, because whatever happens, everything’s going to change in a few weeks (or less!).

Anyway the next steps are that L has even had to book me in provisionally for an induction at 40+6. This is something I did know about as with GD the doc said she wouldn’t let me go past 41 weeks. L said it’s better to get a slot rather than wait until the time and then have to fit in around the availability. I’m hoping it won’t be necessary and B will arrive before then (but not early! Ideally on time / a couple of days late!). I see various docs the week of my due date and so there’s the opportunity then to revisit their recommendations around induction, delivery location etc… I’m thinking the most likely outcome is going to be a fairly medicalised birth at 41 weeks though.

We went through all the birth plan questions (which mainly consisted of me saying I don’t want intervention if I can do it naturally) so L and I are meeting next week to go through the plan. And also she said she’d try and de-medicalise a room for me to try and talk me round and get me feeling better about it! I can be kind of upset about it but ultimately I just have to accept it I think and try and get myself in a good headspace to have the kind of birth I want (even if in a nasty hospital room).

In other news, my sister had her 9+ week scan today and it was great! So I’m feeling hopeful for her. It means by the time I give birth (all being well), she will be around 12 weeks. Maybe this will be easier on her. I know it took a long time for my anxieties to reduce, but equally I feel some selfishness creeping in and wanting to be able to be happy. I feel like for the first half of my pregnancy I was anxious and worried, and then for this latter part, it’s almost been hard to feel happy because of stuff going on with my sister and my brother (which I haven’t talked about on the blog but he’s dealing with something huge). So just to be able to celebrate B’s safe arrival, that would be a big thing. My main thing is I want him to get here safely. And the second thing is I want my family to be able to be happy for me. And not in a way that negates what they are going through – I want them to be happy because they are genuinely happy… I hope that is possible.

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30 comments

With as many complications and changes as I had to deal with, I learned to take a few minutes to let myself be upset, and then just accept things and move on. If I freaked out and stewed on every single change and complication for hours, days, or weeks, I NEVER would have gotten through my pregnancy with an ounce of sanity. Sometimes even if it wasn’t what you want or what you imagined, you have to just roll with the punches. At least you know that your baby will be well monitored while you’re in labor, and if anything happens a team will be right there to jump in and help out. Hopefully you won’t need it, but it’s better to be there and have the resources just in case. Hope you don’t go too far over your due date! Just remember to breathe, and you’ll be fine!

I wanted an unmedicated, natural birth. I got a scheduled c-section for my breech baby. And.. It was fine. No, it was good. We loved the experience and our kid got here safely. Bryson was another scheduled section and he acted like a GD baby and I’m glad we had the close monitoring and specialists. Like you, I was sad to let my dreams go, but my biggest dream was a healthy baby, and then another one. I got both. Had I not scheduled Matthew, he would have gotten stuck with a short cord and been an emergency section and Bryson… He and I both would have died had I labored with him. Be sad and feel disappointed… And then get excited again. Baby boy is coming, and how he gets here really does not matter! ❤

You’re right, of course. We shall see. I have had some development (it’s a long story) so there might be yet another change to the plan, and anyway, I know things don’t necessarily go according to plan on the day! Ha. I’m glad that everything worked out for you in the end. Hopefully it’ll be the same for me!

So I’m all for anything that ensures the safe arrival of a baby! But I also respect the disappointment and sadness that you are feeling as the plans have changed so dramatically and without your support. Sending my love and hoping the experience is better then your expecting right now. ❤

It just seems selfish to whine when ultimately I am very happy and grateful to have got this far. I really didn’t ever think I would. I think it’s mainly because I spent a lot of time getting my head round the idea of giving birth so it’s a big change to what I had spent all the time visualising. But anyway, I had a meeting yesterday with the diabetic obstetrician and she was really positive, so I may yet end up with the birth experience I was looking for! And I know you can’t plan these things!

Shame about the birth plan. Our bubs has been playing silly buggers so ours probably wont get used either (so you’re not alone if that helps). Glad you’re all well though 🙂 great news about your sister! Xx

I planned a natural birth in a hospital, although my private hospital here in Australia has birth centre style rooms and you are encouraged to bring stuff from home to make it your own for labour. I ended up with a scheduled c-section because my body just never went into labour, my cervix did almost nothing even with 24 hours of gel to soften it! My son never engaged in my pelvis even a teeny bit!

In the end, I really enjoyed my section and will do it if we decide to have another baby.

Glad to hear about your sister! Fingers crossed for smooth pregnancy for her and a cousin for B!

Ha, I haven’t heard of people who “really enjoyed” their section so that sounds good! Obviously we will end up going with whatever we’re advised to do in the end. I think there may be yet another change of plan so we shall see what happens!

I know, I am an odd one. But I think it is because my OBGYN really involved me in the decision making process and never made me feel like just another patient. Both my mother and sister had emergency sections for their first babies under general anesthetic so me being awake (as I had a spinal) was a first!

I still get weird looks when I say I was really happy with my experience because people assume you are devastated to miss out on natural birth.

I do agree with others about the need to be flexible, because your birth will almost definitely not go as planned, GD or no GD (not that it’s a bad thing, most people I know are really happy with their not-as-planned births). BUT I just want to add a note that the place I planned to deliver my son was the first/only in-hospital birth center in NYC a couple of years ago (which is ridiculous) and when I was pregnant they had very recently changed their policies because so many women were “risking out” that the center was actually under utilized, even though the demand for it was very high. They changed the cutoff from 40+6 to 41+6 AND changed their policy from GD being an automatic disqualifier, to women with well controlled GD being able to use the birth center as long as baby looks good and the high risk doctor signs off. So don’t let your hospital’s outdated polices make you doubt yourself, you’re totally right in that you could have used the BC and had a safe labor and healthy baby. Sounds like you’re stuck there at this late stage, but if it helps, I didn’t end up in the hotel-like environment of the BC but rather in a regular hospital room with all the wires and an epidural – and it was a fantastic birth that I wouldn’t change for the world. Good luck!!

Yeah, I know I have to be flexible but I kind of thought that meant flexible on the day / depending on what the baby is doing, rather than changing the birth plan before the actual day… but anyway, there’s a chance it might change again so we shall see what happens! I’m glad everything worked out for you in the end!

The lack of control is definitely the hardest thing to deal with.
Very against my nature, but I’ve had to surrender to the fact that I’m a consultant led twin delivery, with 2 lots of monitors I will have no choice but to be tethered to the bed or potentially it’ll be a c-section if twin 1 isn’t head down at the 36 week scan.
Sometimes you just have to go with it and be reassured that the monitor is keeping baby safe and that’s all that really matters.
I hope all goes well and you make it to 40+ weeks. 😊

Ahhh, I hope you are feeling well at this late stage! I’m amazed I’m still going! It seems odd to think there’s an actual human in there, and you have two! Hope that twin turns round by your 36 week scan. Mine is 3/5 engaged so about halfway into the pelvis, apparently!

How frustrating this must be after you complete turned your mind around from a planned c-section to a natural birth! Argh, I feel your frustrations. But not long we will both be holding our little ones and the deliveries will be behind us! It looks like I am going in next Tuesday for a scheduled induction and this little chunker should enter into this world by Wednesday. I am so nervous about the delivery and feel like crying when I talk about it.

Oh wow! Next wednesday! Amazing! That’s actually my official last day “at work” (though I’m working from home) so I’m hoping I make it that far! Ideally don’t want to start my maternity leave early as that means more unpaid time off…! Wishing you all the best for a great birth experience! X

It’s been a year when I was exactly where you are now… (Unbelievable how fast time goes!!!) I had been hoping for a normal, non-induced vaginal birth with minimal intervention and if possible little medication/no epidural. At 41 weeks control the doctor told me that the amount of amniotic fluid had dropped quite a bit, and if we waited for another day or two for the contractions to start naturally, as I had hoped for, we most likely would end up having an emergency c-section. So, at that point, as disappointed as I was- and scared for the induction after reading all sorts of stories about it (not smart..!!)- I of course agreed to induction over possible emergency situation.

The hospital where I gave birth is in a very old building. Outside it looks really nice, but inside not quite so nice, and when we visited the room with our prenatal class I was honestly not impressed… It looked like from another century! Surely, all the machines were modern, but everything else not. And when we visited the lights were all on at the brightest and that gave the room such a cold and uninviting atmosphere, and I was a bit in shock in thinking that this would be the place I would give birth. Funnily enough, it turned out to be that exact room too where my son came into world! But, when it all happened, the lights were not beaming so bright, and at some stage the whole thing takes over, and I was inside my own bubble where I did not pay any attention to my surroundings.

Now, a year later, it all seems so secondary how the place looked like. But I’m not saying that it doesn’t matter at all, because of course how one feels about a place is important! (I pay a lot attention to my surroundings, suck in atmosphere, and like beautiful deco.) I guess what I’m trying to say is that don’t get discouraged by the switch, lot can be done like your midwife suggested (with the lights and all)!

Thank you for this. That pretty much puts into words how I feel. I think you are right and I won’t notice the surroundings so much once I’m actually “in the zone” – so I probably just need to chill out. I think it’s just weird to change my mental image of what will happen. Although there may be another development as I met with the diabetic obstetrician yesterday and everything changed again! So we shall see!! Thanks for sharing your experience. X

Oh I’m so sorry that landed this in you at the last minute. That totally blows. They insist that vbac births have CFM (continuous detail monitoring) too and there are a bunch of people on my vbac page railing about it constantly. I didn’t really mind as it didn’t bother me but during my labour they let me switch to the Doppler type monitoring so I could spend more time in the bath (waterproof mobile monitor wasn’t working properly). My plan of action was always to just go with the flow and then fight a battle of I needed to rather than go in guns blazing which tends to make people more resistant. There is some research around now suggesting that CFM doesn’t actually improve outcomes so do a google and see what you can find out there. If I get the chance I will chase up the link on the vbac page and post for you. It is such a hard one and I totally understand how you feel. Of course you dont want to deny life saving care to your baby and they put you in this position by insisting on something that makes them feel better but isn’t necessarily life saving. It is frustrating. The other thing is that if it is a public NHS hospital then they can’t make you do anything. If you turn up in labour they can’t send you home if you won’t wear the monitor 24/7. Anyway, just do what you feel is right. Oh and my doula did the whole electric candles around my bath and honestly it was beautiful, didn’t feel like a hospital at all! So L de-medicalising your room will make a massive difference. It can still be wonderful, I promise xxx

Thank you! I have been coming to terms with it over the past few days. I know it sounds stupid but I think it took me a lot of time to get this far mentally so I just had to sort of change my visualisations about it… I’m sure I will be okay in the end! The important thing is that B gets here safely so ultimately I just have to concentrate on that! I appreciate you sharing your experience. Especially that you don’t notice the CFM too much! I bet once labour gets going, I won’t even notice anything else! 🙂 x

Would you be able to make the hospital suite more of a home feeling? Since in America most of us give birth in a hospital setting with doctors and machines and stuff I have heard/seen many women bringing in lamps and having the lights turned off, bringing their own pillow, sheets, and blanket that makes them feel at home, music to play in the background, etc. anything that makes you feel at peace that is allowed by the hospital. Honestly, the pain I was in for the 26 hours of the induction before the c-section I could have cared less where I was at…I just wanted the pain gone. The things you think about when in pain are “when will this pain end?” Not “I really wish the wall paint was a different color”.

I hope you are able to wrap your mind around a more hospital setting but it sounds like it’s the best option available for your situation. Also, I really liked being hooked up to the monitor bc I didn’t really feel him moving around much during labor and hearing is heartbeat the whole time was a relief.

Thank you!! I’ve done a bunch of thinking about it and I’m feeling much better. I’m not going to bring in my own dog-hair covered sheets 😂😂 but we are bringing candles (battery!) and fairy lights and music so we can try and make the best of it. And I’m sure you are right that I won’t be focusing on the stuff outside of the birth! Thank you for sharing your experience! X